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Real-time Claim Status Coming October 2012

Release Date: July 27, 2012

Blue Cross and Blue Shield of North Carolina (BCBSNC) will be offering real-time claim status connectivity this October for all trading partners that are CAQH CORE certified. Two new connectivity protocols, SOAP + WSDL and HTTP + MIME, will be available for both Health Eligibility (270/271) and Claim Status (276/277) transaction types. Real-time and batch file formats will be available for these transactions. This offering makes BCBSNC compliant with CAQH/CORE operating rules that support the Affordable Care Act.  The Department of Health and Human Services (DHHS) has adopted these operating rules, and has mandated compliance by January 1, 2013. 

A key change for CAQH CORE Phase II is the addition of real-time capabilities to the Claim Status transaction.   Like the Health Care Eligibility request, BCBSNC must respond to real-time claim status requests within 20 seconds.  Becoming CAQH CORE certified and utilizing the real-time capabilities promotes the following:

  1. Enhanced interoperability between providers and payers
  2. Streamlined eligibility, benefits, and claim status transactions
  3. Reduced time providers spend on administrative functions

For more information on becoming CAQH CORE certified and specifics regarding the CORE Operating Rules, visit the CAQH website.  Details regarding changes to the BCBSNC Health Care Eligibility and Claim Status transactions are outlined in our Companion Guide located at the BCBSNC HIPAA 5010 Companion Guides.

For more information on how to enroll in BCBSNC’s real-time offerings, email the eSolutions Help Desk at EDICUSSUP@bcbsnc.com.

 

Acronym

Definition

CAQH

Council for Affordable Quality Healthcare (a nonprofit alliance of health plans and trade associations)

CORE

Committee on Operating Rules for Information Exchange (a CAQH initiative that identifies standards in HC data exchange)

SOAP

Simple Object Access Protocol ( a web-based information exchange protocol)

HTTP

Hypertext Transfer Protocol

MIME

Multipurpose Internet Mail Extension

WSDL

Web Services Description Language